Pathophysiology of the Hand and Wrist Flashcards
the intrinsic extensors at the hand/wrist primarily extend at what joint?
MCP
trigger fingers tend to occur at what pulley?
A1 pulleys
what is a Boutonniere’s deformity?
central slip dysfxn at the middle phalanx
triangular ligament attenuation
volar migration of the lateral bands
Boutonniere’s deformity is ____ of the MCP, ____ of the PIP, and ____ of the DIP
extension, flexion, extension
what are some interventions for Boutoniere’s deformity?
surgical repair
splinting to keep the PIP in a more extended position
t/f: Boutonniere’s deformity causes friction over the radial styloid
true
what is the etiology of a Swan neck deformity?
disruption of the volar pulley at the PIP
flexor tendon rupture at the PIP and extensor tendon at the DIP
Swan neck deformity is ____ of the PIP and ____ of the DIP
extension, flexion
t/f:there are deficits in active PIP flexion with a Swan neck deformity
true
what are some interventions for Swan neck deformity?
surgical repair
splinting to facilitate PIP flexion
what is the etiology of DeQuervain’s tenosynovitis?
tenosynovitis of the APL and EPB due to CTD (cumulative trauma disorder ie overuse)
what are the s/s of DeQuervain’s tenosynovitis?
pain at the base of the thumb
pain at the radial styloid
what are some interventions for DeQuervain’s tenosynovitis?
reduce edema
splinting
NSAIDs
stretch/ROM
surgical release
t/f: DeQuervain’s tenosynovitis causes friction over the radial styloid
true
t/f: resistance will usually cause pain in DeQuervain’s tenosynovitis
true
if there is a (-) Finkelstein test and pain in the snuff box, what may be going on?
fx
if DeQuervain’s tenosynovitis is chronic is it easier or harder to treat?
harder to treat
t/f: steroid injection are a common treatment for DeQuervain’s tenosynovitis
false, steroid injection may cause breakdown of the tendons, putting them at risk for rupture
what is the test most commonly used for DeQuervain’s tenosynovitis?
Finkelstein test
how many tendons cross the wrist?
12
where does the FCR insert?
on the 2nd and 3rd metacarpals
where does the FDS insert?
on the base of the middle phalanx
where does the FDP insert?
on the base of the distal phalanx
what motion does the FDS produce?
PIP flexion
t/f: the FDP is 50% stronger than the FDS
true
what are the 2 bundles of the FDP?
one bundle from the radius to the index finger
another bundle from the ulna to the long, ring, and pinky fingers
what is the Quadriga effect?
the distal tendon of 1 finger limits the active motion of other tendons bc of their shared muscles belly
t/f: the excursion of combined tendons is equal to the shortest tendon’s excursion
true
how long does it take to regain tensile strength of tendons?
12 weeks to a year
adhesions tend to form where?
in zones 1 and 2 (distal hand in the fingers)
t/f: PROM helps eliminate adhesions
false, ACTIVE flexion is required to move the tendons through the proximal pulley (A1 pulleys)
what are the primary intervention strategies for management of flexor tendon ruptures and repairs?
edema control
scar management
passive finger flexion
active finger extension
t/f: full IP extension must be attained immediately post-op flexor tendon repair/rupture but extension at the MCP, PIP, and DIP places adverse stretch
true
t/f: passive finger extension is avoided in early stages of flexor tendon ruptures/repairs bc of tension it puts on the tendons
true
what does a dorsal blocking splint for post flexor tendon repair?
allows MCP flexion w/full IP extension
t/f: full wrist and finger extension is not allowed until later stages of flexor tendon repair/rupture
true
active finger flexion is started at ___ weeks post flexor tendon repair if 40-50 deg difference bw PROM and AROM
4
t/f: the MCP may be splinted in slight flexion (15-20 deg) to maintain the length of the collateral ligs
true
what is a trigger finger?
thickening of the flexor tendon sheath or tendon typically at the A1 pulleys causing “snapping” as the nodule pulls through the pulley
what is the MOI of trigger finger?
insidious or due to repetitive gripping of sharp edges
t/f: there is a palpable nodule on the flexor tendon with a trigger finger
true
what are the intervention strategies for trigger finger?
rest
hand-based splint with MCP jt at 0 deg that allows full PIP motion
injections
surgery followed by progression to light strengthening
t/f: there is strong evidence for modalities to treat trigger finger
false, there is weak evidence
what structures run through the carpal tunnel?
median nerve a 9 tendons
what tendons run through the carpal tunnel?
FPL
4 FDS tendons
4 FDP tendons
why is the median nerve at risk in the CT?
bc it is the weakest structure, so it tends to get compressed
what are the tests for CTS (carpal tunnel syndrome)?
Tinel
Phalen/reverse
CT compression
how can we manage CTS?
activity modification
wrist mobs
tendon glides
neuromobilization (median nerve glides)
splinting to hold the hand in just a couple deg of ext (15-20)
bike fitting
modalities
surgery
what activity modification can be given for CTS?
neutral wrist in typing on the computer
where is the Tunnel of Guyon?
on the ulnar side of the wrist
what nerve is effected in the tunnel of Guyon?
the ulnar nerve
what are the tests for TFCC pathology?
TFCC load test
TFCC stress test
gripping rotatory impaction test (GRIT)
with a (+) GRIT, would pronation or supination be stronger?
supination would be stronger for a (+) GRIT
what are ways to manage TFCC syndrome?
reduce pain and swelling
restore movt
RESTORE/REHAB STRENGTH AND FXN
surgical repair/debridement
what is the MOI of TFCC syndrome?
axial loading with compression through the wrist
forceful twist
t/f: TFCC syndrome involves wearing of the central portion
true
t/f: TFCC syndrome is often a chronic condition
true
disc perforations are present in what % of those over 50 with TFCC syndrome?
50-60%
a colles fx is ___ angulation
dorsal
collies fx is usually due to what MOI?
FOOSH injury
t/f: a colles fx leads to ROM limitations that we may or may not be able to fully regain
true
what are the tests we learned for jt and bone conditions of the wrist and hand?
Watson scaphoid instability test
axial loading test
other than scaphoid fx, what else could the axial loading test tell us about?
CMC or MCP arthritis
is game keeper’s thumb chronic or acute?
chronic
is skiers thumb chronic or acute?
acute
how is gamer keeper’s thumb/skier’s thumb managed?
thumb spica splint
modalities to control pain and inflammation
ROM to tolerance
eventually strengthening
what is a game keeper’s thumb/skier’s thumb?
tear of the UCL of the 1st MCP
what is a Boxer’s fx?
fx of the 5th metacarpal
what is the test for lunate dislocation?
Murphy’s sign
